Download Disorders and Treatment

Unit XII:
Disorders & Treatments
Psychological Disorders
Mental Health Hotline
1 (800)555-HELP
Stats on Psychological Disorders
1. Roughly 2 million people in the US are in-patients in psychiatric units. They are
under lock & key for the most serious disturbances.
2. Over 2.4 million people in the US are residents in group homes, shared living
spaces that provide assistance to transition into a community.
3. Roughly 15% of Americans utilize services for treatment of a psychological
disorder. People use medication (such as Xanax for anxiety) or treatment of a therapist.
4. Over 400 million people worldwide are in need of some form of psychological
assistance.
5. Depression and schizophrenia exist in all cultures of the world.
• Mark these statements as TRUE or FALSE
• Abnormal behaviors are always bizarre
• A clear distinction can be drawn between “normal” and
“abnormal” behaviors.
• As a group, former mental patients are unpredictable and
dangerous.
• Mental disorders indicate a fundamental deficiency in
personality, and are thus shameful.
• Because mental illness is so common, there is reason to be
fearful of one’s own vulnerability.
• Geniuses are particularly prone to emotional disorders.
• Most mental disorders are incurable.
What is Abnormal?
After each of the descriptions below place an “A” (for abnormal) or an “N” (for normal) based on your
analysis of each person.
1. Terry has been having terrible nightmares at least three times a week from which he wakes up shaking
and sweating. ______
2. Vanda has visions and hallucinations that she often uses to guide her important decisions. ______
3. Alana always covers her face when she goes out in public. ______
4. Sandy has been plotting to assassinate the governor the next time she appears locally. _______
5. Even though public transportation is easily accessible, Tom drives to work during a summer ozone alert
when the mayor has asked people to use their cars as little as possible. ______
6. Beth continues to be very upset about her sister’s death, even though the accident that killed her
happened two years ago. She still wears dark mourning clothes and cries almost every day whenever she
thinks of her sister. ______
7. Harry is so fearful of crowds that he can no longer ride the bus to work. ______
8. Luke often urinates on the street. ______
Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Bob is a very intelligent, 25 year old member of a
religious organization that is based on Buddhism.
Bob’s working for this organization caused
considerable conflict between him and his parents,
who are devout Catholics. Recently Bob experiences
acute spells of nausea and fatigue that prevent him
from working and which have forced him to return
home to live with his parents. Various medical tests
are being conducted, but as yet no physical causes
of his problems have been found.
Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Jim was vice president of the freshman class at a
local college and played on the school’s football
team. Later that year he dropped out of these
activities and gradually became more and more
withdrawn from friends and family. Neglecting to
shave and shower, he began to look dirty and
unhealthy. He spent most of his time alone in his
room and sometimes complained to his parents that
he heard voices in the curtains and in the closet. In
his sophomore year he dropped out of school
entirely. With increasing anxiety and agitation, he
began to worry that the “Nazis” were plotting to kill
his family and kidnap him.
Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Mary is a 30 year old musician who is very dedicated
and successful in her work as a teacher in a local
high school and as a part time member of local
musical groups. Since her marriage five years ago,
which ended in divorce after six months, she has
dated very few men. She often worries that her time
is “running out” for establishing a good relationship
with a man, getting married, and raising a family.
Her friends tell her that she gets way too anxious
around men, and that she needs to relax a little in
general.
Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Larry, a homosexual who has lived for three
years with a man he met in graduate school,
works as a psychologist in a large hospital.
Although competent in his work, he often
feels strained by the pressures of his
demanding position. An added source of
tension on the job is his not being able to
confide in all his co-workers about his private
life. Most of his leisure activities are with
good friends who belong to the gay
community.
It’s All a Matter of Degree
Psychological Disorders
People are fascinated by the exceptional, the
unusual, and the abnormal. This fascination
may be caused by two reasons:
1.
During various moments we feel, think, and act like
an abnormal individual.
2.
Psychological disorders may bring unexplained
physical symptoms, irrational fears, and suicidal
thoughts.
Defining Psychological Disorders
Mental health workers view psychological
disorders as persistently harmful thoughts,
feelings, and actions.
When behavior is deviant, distressful, and
dysfunctional psychiatrists and psychologists
label it as disordered (Comer, 2004).
Deviant, Distressful & Dysfunctional
1.
3.
Carol Beckwith
2.
Deviant behavior (going
naked) in one culture
may be considered
normal, while in others
it may lead to arrest.
Deviant behavior must
accompany distress.
If a behavior is
dysfunctional it is
clearly a disorder.
In the Wodaabe tribe men
wear costumes to attract
women. In Western society
this would be considered
abnormal.
WHAT MAKES SOMETHING A PSYCHOLOGICAL
DISORDER?
Atypical - The behavior is not just quirky;
however, it is considered extremely odd.
Maladaptive - A psychological disorder makes
everyday life difficult for an individual. It
typically interferes with the ability to lead a
normal life.
Unjustifiable - A psychological disorder is not
easy to explain to most people.
Disturbing – varies with time & culture
For example, a person might engage in behavior that calls a great deal
of attention to her. The behavior may not make sense to an outsider,
but the person with the disorder does not know how to act otherwise.
Understanding Psychological Disorders
Ancient Treatments of psychological disorders
include trephination, exorcism, being caged like
animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.
Trephination (boring holes in the skull to remove evil forces)
Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
1.
Etiology: Cause and development of the disorder.
2.
Diagnosis: Identifying (symptoms) and distinguishing
one disease from another.
3.
Treatment: Treating a disorder in a psychiatric hospital.
4.
Prognosis: Forecast about the disorder.
Theories of Psychopathology - Biological Approach
 Mental disorders are seen as caused by the
combination and interaction of biological,
psychological, and socio-cultural factors
 Ancient Greece (Hippocrates) –
 imbalance between four humors, or bodily fluids (blood,
phlegm, black bile, and yellow bile)
 Ancient China  imbalance of yin and yang
 Modern view –
 disturbances in the anatomy and chemistry of the brain
and in other biological processes, including genetic
influences
Theories of Psychopathology Psychodynamic Approach
 Ancient Greece – psyche
 Disorders are a result of the mind’s struggles to resolve
inner conflicts or to overcome the effects of stressful
events.
 Freud
 Disorders are the result of unresolved, mostly
unconscious conflicts that begin in childhood
 Humanistic Approach
 Disorders appear when a person’s natural tendency
toward healthy growth is blocked, usually by a failure to
be aware of, and to express, true feelings
Theories of Psychopathology - Behavioral Approach
 Classical conditioning
 Responses associated with stimuli as a result of
previous experience
 Example: Phobias
 Operant conditioning
 Responses associated with consequences as a
result of previous experience
 Behaviors that have been learned and continue even
though they are maladaptive
 Social-cognitive theorists, also known as social
learning theorists see most psychological
disorders as resulting from the interaction of
past learning and current situations
Theories of Psychopathology - Cognitive-Social Approach
 What is “appropriate” and “expected” depends on
age, gender, and culture, as well as on the
particular situation and historical era in which
people find themselves
 Depression higher in women
 Alcohol abuse higher in men
 Cultural differences
 Behaviors that are acceptable in one culture but
not in another culture
 Culture specific disorders
Theories of Psychopathology - Bio-Psycho-Social Perspective
 Assumes that biological, sociocultural,
and psychological factors combine and
interact to produce psychological
disorders.
How do genetics and
environment interact
to create
psychological disorders?
Peanut Butter, Jelly, and the Diathesis-Stress Model
The diathesis-stress model emphasizes the joint occurrence
of maladaptive behavior and high levels of stress.
I need four volunteers to make PB & J Sandwiches.
Psychological
Disorders Etiology
§
DSM-5
§
§
§
American Psychiatric Association’s
Diagnostic and Statistical Manual
of Mental Disorders
a widely used system for
classifying psychological disorders
presently distributed as DSM-5
DSM-IV-TR Multiaxial Classification
Is a Clinical Syndrome (cognitive, anxiety,
Axis I
mood disorders [16 syndromes]) present?
Axis II
Is a Personality Disorder or Mental
Retardation present?
Is a General Medical Condition (diabetes,
Axis III
hypertension or arthritis etc) also present?
Are Psychosocial or Environmental Problems
Axis IV
(school or housing issues) also present?
What is the Global Assessment of the
Axis V person’s functioning?
DSM-5 Definition of Mental Disorder
 A syndrome that causes clinically
significant problems with cognitions,
emotion regulation, or behavior that
results in dysfunctional mental
functioning and is associated with
significant distress or disability in
social, occupational, or other
important activities.
ICD-10 and WHODAS
 Both originate from the World Health Organization
 ICD-10: International Classification of Diseases
 Codes for documents such as health records and death
certificates
 Used to capture national morbidity and mortality
statistics
 WHODAS: World Health Organization’s Disability
Assessment Schedule
 A measurement of functioning
 A system of diagnosis used world wide
20 Classifications of Disorders
 Neurodevelopmental
 Schizophrenia Spectrum
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and Other Psychotic
Disorders
Bipolar and Related
Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and
Related Disorders
Trauma and StressorRelated Disorders
Dissociative Disorders
Somatic Symptom and
Related Disorders
Feeding and Eating
Disorders
Elimination Disorders
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Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, ImpulseControl, and Conduct
Disorders
Substance Related and
Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other
 Plus, there is a category
for general medical issues
and medication induced
disorders
DSM-5
 Dimensional Approach
 Not a presence or absence of a
symptom or particular set of
symptoms
 Recognizes how conditions relate to
each other on a continuum of
behavior
 Groupings or clusterings of
disorders often happen
(comorbidity)
 Internalizing Factors
 Those in which anxiety,
depressions, and somatic
symptoms are prevalent
 Goes on inside the mind and
within the body
 mild – moderate – severe
 Externalizing Factors
 5 major aspects to consider:
 Course
 Severity
 Frequency
 Duration
 Descriptive features
 Demonstrates disturbances of
Unit XII. Disorders and Treatment
conduct, impulse control, and
substance abuse
 Exhibits itself to society
 outside the mind
 DSM-5 Focus on
Culture and Gender
 More gender and culturally
sensitive by providing varied
definitions and further background
on both arenas
 Example: Social Anxiety Disorder
 Developmental Focus
Across the Lifespan
incorporates fear of offending
others as part of something Asian
cultures may experience
 Begins with Neurodevelopmental
Disorders which are noticed at a
young age
 Ends with Neurocognitive
Disorders which are noticed at
old age
 Recognizes familial aspects to
disorders
 Recognizes how disorders
develop at different stages of
life and how they progress
across the lifespan
Unit XII. Disorders and Treatment
Alternative Personality Model
 Retains 6 categories:

.
 Antisocial
 Avoidant
 Borderline
 Narcissistic
 Obsessive-Compulsive
 Schizotypal
 A separate category is created:
 PD-TS: Personality Disorder-Trait Specific
 For people who meet general criteria of a Personality Disorder but do
not fit all aspects of any one specified disorder
 All other Personality Disorders are relocated within the broader
20 categories, grouped by type of symptoms and characteristics
Unit XII. Disorders and Treatment
Psychological Disorders
TED Talk: Strange Answers to the Psychopath Test
--Jon Ronson--
9 Major Categories of Psychological Disorders
ANXIETY, OBSESSIVE-COMPULSIVE, TRAUMA and STRESSOR
DISORDERS:
Anxiety in general is a combination of physical, cognitive, and
psychological symptoms in which a person’s sympathetic nervous
system has initiated a fight-or-flight response.
Anxiety is very common among people in the US. In general,
however, it is situational - we can usually point to the cause of
the anxiety.
When we cannot identify the cause, it is more problematic.
Currently, the DSM-5 defines General Anxiety Disorder or GAD as
“anxiety and worry that is excessive and difficult to control and
that occurs more days than not for a period of at least 6
months.”
GAD also includes symptoms of fatigue,
restlessness, irritability, sleep disturbances,
decreased concentration and memory, and
muscle tension.
Model of Development of General
Anxiety Disorder (GAD)
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GAD has some genetic component
Childhood trauma related to GAD
More or less constant worry about many
issues that SERIOUSLY interferes with
functioning
Symptoms: headache, stomachache, muscle
tension, irritability
Genetic predisposition
or childhood trauma
Hypervigilance
GAD following life
change or major event
Panic Attack
Marked by minutes-long episode of
intense dread in which a person
experiences terror and accompanying
chest pain, choking, or other frightening
sensation.
PANIC DISORDER:
A panic disorder occurs when
someone has uncontrollable
panic attacks for an extended
period of time (longer than two
weeks). The typical panic attack
involves shortness of breath,
racing heart, and an unfocused
feeling of being out of control.
The attacks come on rapidly and
are debilitating.
Phobia
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
Phobias -
persistent, irrational fear of
a specific object or situation

Intense, irrational fears that may focus
on:
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Natural environment—heights, water,
lightening
Situation—flying, tunnels, crowds, social
gathering
Injury—needles, blood, dentist, doctor
Animals or insects—insects, snakes, bats,
dogs
Kinds of Phobias
Agoraphobia
Acrophobia
Phobia of open places.
Phobia of heights.
Claustrophobia
Phobia of closed
spaces.
Hemophobia
Phobia of blood.
OBSESSIVE-COMPULSIVE DISORDER (OCD):
Types of Anxiety Disorders
OCD involves having obsessive stress or anxiety
over a particular event or issue and performing
ritualistic or compulsive behavior to
ameliorate the stress. Obsessive behavior is
fairly common: it becomes a disorder when the
compulsive behavior impairs everyday life.
OCD involves unwanted repetitive thoughts
(obsessions) and/or actions (compulsions)
I felt the need to clean my room … spent four to five
hour at it … At the time I loved it but then didn't
want to do it any more, but could not stop … The
clothes hung … two fingers apart …I touched my
bedroom wall before leaving the house … I had
constant anxiety … I thought I might be nuts.
Marc, diagnosed with
obsessive-compulsive disorder
(from Summers, 1996)
Obsessive-Compulsive
Obsessive-Compulsive
§
§
PET Scan of brain of
person with Obsessive/
Compulsive disorder
High metabolic activity
(red) in frontal lobe
areas involved with
directing attention
Movies that have tackled the issue of PTSD.
PTSD
POST-TRAUMATIC STRESS
DISORDER (PTSD): PTSD occurs
when someone has gone through a
traumatic event. That event, or the
memory of that event, causes the
person to continuously reexperience the stress associated
with that event. Re-experiencing
of the event can take the form of a
panic attack.
Experiencing or
witnessing severely
threatening,
uncontrollable events
with a sense of fear,
helplessness, or horror
Symptoms:
•
•
•
•
•
Haunting memories
Nightmares
Social withdrawal
Jumpy anxiety
Insomnia
Resilience to PTSD
Only about 10% of women and 20% of men react
to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
Explaining Anxiety Disorders
Psychoanalytic Perspective
Freud suggested that we repress our painful
and intolerable ideas, feelings, and thoughts,
resulting in anxiety.
The Learning/Behavioral
Perspective
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Sees anxiety disorders as a product of
learned helplessness or fear conditioning
Researchers have linked general anxiety
with classical conditioning of fear.
Observational Learning

We learn fear through observing others.
Parents transmit their fears to their children.
The Biological Perspective
Considers possible evolutionary, genetic, and
physiological influences.
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Natural Selection - Phobias focus on dangers faced
by our ancestors. Compulsive acts typically
exaggerate behaviors that contributed to our species’
survival.
Genes - Some people seem genetically predisposed
to particular fears and high anxiety. Identical twins
often develop similar phobias, even when raised
separately.
Physiology - General anxiety, panic attacks, and
even obsessions and compulsions are biologically
measurable as an overarousal of brain areas involved
in impulse control and habitual behaviors. (PET scans)
9 Major Categories of Psychological Disorders
SOMATIC SYMPTOM and RELATED
DISORDERS:
psychological disorders in which the symptoms
take a somatic (bodily) form without apparent
physical cause, though they may or may not
have a diagnosed medical condition
The key feature is EXCESSIVE RESPONSE—
marked thoughts, feelings, and behaviors in
excess of what would be expected
Types of SOMATIC DISORDERS
CONVERSION DISORDER:
A person will suffer from a great deal of stress
concerning an upcoming event. As a
strategy for dealing with the stress, the
person will “convert” the stress into some
physical ailment.
For example, if a person is anxious because she
has to give an oral presentation to her class,
she might suddenly develop a cause of
laryngitis the day before. In such a situation,
the stress was “converted” into the problem of
not being able to talk.
FACTITIOUS DISORDER:
It involves an unsubstantiated belief about a
person’s illness or the illness of another
9 Major Categories of
Psychological Disorders
DISSOCIATIVE DISORDERS:
A dissociative disorder is one in which there
is a break in the connection between
reality and perception of reality.
In most cases, this gives rise to an
inability to deal with reality; what is
real and what seems real are not the
same.
Dissociative Disorders
Amnesia
Memories
related to a
trauma
disappear. When
you can’t
remember
somebody being
shot in front of
you.
Fugue
Identity Disorder
A person will have
several personalities
that are unique,
VERY rare and
controversial.
Memories related
to a
trauma
disappear and
the person starts
life all over. The
kind of amnesia
in movies ie.
Jason Bourne.
Dissociative Amnesia

Margie and her brother were recently
victims of a robbery. Margie was not
injured, but her brother was killed
when he resisted the robbers. Margie
was unable to recall any details from
the time of the accident until four
days later.
Dissociative Fugue
• Jay, a high school physics teacher in
New York City, disappeared three days
after his wife unexpectedly left him for
another man. Six months later, he was
discovered tending bar in Miami Beach.
Calling himself Martin, he claimed to
have no recollection of his past life and
insisted that he had never been
married.
Depersonalization and Derealization
Conscious awareness becomes separated
(dissociated) from previous memories,
thoughts, and feelings.
Symptoms
Having a sense of being unreal.
Being separated from the body.
Watching yourself as if in a movie.
Dissociative Identity Disorder

Dissociative Identity Disorder
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
rare dissociative disorder in which a person
exhibits two or more distinct and
alternating personalities
formerly called multiple personality
disorder
Dissociative Identity Disorder
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Pattern typically starts prior to age 10
(childhood)
Most people with disorder are women
Most report recall of torture or sexual
abuse as children and show
symptoms of PTSD
Dissociative Identity Disorder
(DID)
Norma has frequent memory gaps and cannot
account for her whereabouts during certain
periods of time. While being interviewed by a
clinical psychologist, she began speaking in a
childlike voice. She claimed that her name
was Donna and that she was only six years
old. Moments later, she seemed to revert to
her adult voice and had no recollection of
speaking in a childlike voice or claiming that
her name was Donna.
Causes of Dissociative Disorders?
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Repeated, severe sexual or physical
abuse
However, many abused people do not
develop DID
Combine abuse with biological
predisposition toward dissociation?
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people with DID are easier to hypnotize than others
may begin as series of hypnotic trances to cope with
abusive situations
DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID has
not been found in other countries.
Critics’ Arguments
Role-playing by people open to a
therapist’s suggestion.
Learned response that reinforces
reductions in anxiety.
The DID Controversy
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Some curious statistics
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1930–60: 2 cases per decade in USA
1980s: 20,000 cases reported
many more cases in US than elsewhere
varies by therapist—some see none, others
see a lot
Is DID the result of suggestion by
therapist and acting by patient?
YouTube Video: Herschel Walker - DID, Part I
YouTube Video: Herschel Walker DID, Part 2
9 Major Categories of Psychological Disorders
SCHIZOPHRENIA SPECTRUM:
Schizophrenia is not, as many people think, the
same thing as dissociative identity disorder
(or multiple personality disorder).
Symptoms:

Disorganized thoughts, Hallucinations – auditory
“Hear voices,” Delusions, Garbled speech, Word
salad, Clanging
Difficult time dealing with reality and often suffers
because one cannot articulate the issue.
Equally split between genders, earlier onset with
males
Louis Wain (1860–1939) was an English
artist best known for his drawings, which
consistently featured anthropomorphised
large-eyed cats and kittens.
In his later years he suffered from
schizophrenia, which, according to some
psychologists, can be seen in his works.
YouTube Clip: From "Lord of the Rings, The Two Towers", Gollum shows signs of schizophrenia.
YouTube: Lord of the Rings Scene - Gollem
CATATONIA:
Marked by periods of complete immobility called
waxy flexibility.
The person with catatonic schizophrenia will stop
moving and remain in that position for several
minutes.
During that period of immobility, the person’s arms can be moved, and
they will remain in that position until the catatonic phase passes.
Some have attributed this immobility to mild epileptic seizures, but we
are not certain why this occurs.
Symptoms of Schizophrenia
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Chronic or process
schizophrenia is a slow-developing
process; recovery is doubtful.
Acute or reactive
schizophrenia develops rapidly;
recovery is much more likely.
Schizophrenia
§
Delusions
§
§
false beliefs, often of persecution or grandeur, that
may accompany psychotic disorders
In a psychiatrist's waiting room two patients are having a
conversation. One says to the other, "Why are you here?"
The second answers, "I'm Napoleon, so the doctor told me to
come here."
The first is curious and asks, "How do you know that you're
Napoleon?"
The second responds, "God told me I was."
At this point, a patient on the other side of the room shouts,
"NO I DIDN'T!"
Symptoms of Schizophrenia
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Delusions of persecution
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Delusions of grandeur
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‘they’re out to get me’
paranoia
“God” complex
megalomania
Delusions of being controlled

the CIA is controlling my brain with a radio
signal
Symptoms of Schizophrenia
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Hallucinations
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hearing or seeing things that aren’t there
contributes to delusions
command hallucinations: voices giving orders
Disorganized speech
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Over-inclusion—jumping from idea to idea without the
benefit of logical association
Paralogic—on the surface, seems logical, but seriously
flawed
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e.g., Jesus was a man with a beard, I am a man with a beard,
therefore I am Jesus
Disorganized Symptoms
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Disorganized behavior and affect
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behavior is inappropriate for the situation
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affect is inappropriately expressed
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e.g., wearing sweaters and overcoats on hot days
flat affect—no emotion at all in face or speech
inappropriate affect—laughing at very serious
things,
crying at funny things
catatonic behavior

unresponsiveness to environment, usually marked
by immobility for extended periods
Disturbed Perceptions
A schizophrenic person may perceive things
that are not there (hallucinations). Frequently
such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
What Schizophrenia might feel
like…
74
Positive and Negative Symptoms
Schizophrenics have inappropriate symptoms
(hallucinations, disorganized thinking, deluded
ways) that are not present in normal individuals
(positive symptoms).
Schizophrenics also have an absence of
appropriate symptoms (apathy, expressionless
faces, rigid bodies) that are present in normal
individuals (negative symptoms).
Frequency of positive and negative symptoms in individuals at the time
they were hospitalized for schizophrenia. Source: Based on data reported
in Andreasen & Flaum, 1991.
Chemical Factors
in Schizophrenia
1. Dopamine is a neurotransmitter found in the brain.
2. Schizophrenics have very high levels of dopamine.
3. They report that they feel agitated, talk
rapidly, and their thoughts are racing.
4. Some schizophrenics report that lower levels
of dopamine make them feel better.
5. Drugs that reduce dopamine reduce symptoms, and
drugs that increase dopamine produce symptoms
even in people without the disorder. The Theory:
Schizophrenia is caused by excess dopamine
Genetic
Factors
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1 in 100 odds of any
person being diagnosed
with schizophrenia.
1 in 10 chance among
those who have an
afflicted sibling or
parent.
1 in 2 chance among
those who have an
afflicted identical twin.
Biological Factors
Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
Abnormal Brain Activity
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients. Adolescent
schizophrenic patients also have brain lesions.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
Other Biological Factors

Brain structure and function



Early warning signs



enlarged cerebral ventricles and reduced neural
tissue around the ventricles
PET scans show reduced frontal lobe activity
nothing very reliable has been found yet
certain attention deficits can be found in children
who are at risk for the disorder
Father’s age—older men are at higher risk
for fathering a child with schizophrenia
Environmental Factors
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection (flu)
during the middle of their fetal development.
Cultural Differences in Schizophrenia


Prevalence of symptoms is similar no
matter what the culture
Less industrialized countries have better
rates of recovery than industrialized
countries



families tend to be less critical of the patients
less use of antipsychotic medications, which may
impair full recovery
think of it as transient, rather than chronic and lasting
disorder
YouTube Clip: Inside the World of Childhood Schizophrenia 20/20 abcnews
TED Talk: a schizophrenic’s speech
85
9 Major Categories of Psychological Disorders
Personality Disorders:
Pervasive pattern of behavior involving difficulty
interacting with others. Usually without anxiety,
depression or delusions
Some of the most misunderstood disorders in psychology.
We have neither a complete grasp of the causes nor an
adequate strategy for treatment.
Paranoid Personality Disorder
Watching for injustice

Pervasive mistrust and suspiciousness of others are
the main characteristic

Distrustful even of close family and friends

Reluctant to form close relationships--extreme jealousy





Tend to blame others for their own shortcomings
A pervasive and unwarranted belief that others
intend to harm
Expecting to be exploited
Interpreting others motives as malevolent
Taking remarks out of context and interpreting them
to support own frame of reference
Schizoid Personality Disorder:
Detached loner








Pervasive indifference toward others
Restricted range of emotional expression
Unaffected by praise or criticism
Few friends or confidants
Maintains superficial connections with
relatives; even these are aloof and cool
No sense of humor
Lacks social skills
No overtly bizarre behavior, thinking, etc.
Schizotypal Personality Disorder:
Peculiarity/eccentricity









Acutely uncomfortable around others; esp. those
who are unfamiliar
Deficient in social relationships
Reduced capacity for closeness
Peculiar in thought, action, appearance
Bizarre fantasies and preoccupations
Unkempt, mismatched, prefer to dress in strange
clothing
Digressive or vague in speech
Use words differently than others: neologisms
Talk to themselves openly
Antisocial Personality
Disorder
§
§
§
disorder in which the person
(usually man) exhibits a lack of
conscience for wrongdoing,
even toward friends and family
members
may be aggressive and ruthless
or a clever con artist
These people consistently come
into conflict with the law and
show little or no concern, guilt,
or anxiety.
Understanding Antisocial Personality
Disorder
Like mood disorders and
schizophrenia, antisocial
personality disorder has
biological and
psychological reasons.
Youngsters, before
committing a crime,
respond with lower
levels of stress
hormones than others do
at their age.
Personality Disorders
§
PET scans illustrate reduced activation in
a murderer’s frontal cortex
Normal
Murderer
Understanding Antisocial
Personality Disorder
The likelihood that one will commit a crime doubles
when childhood poverty is compounded with
obstetrical complications (Raine et al., 1999; 2000).
Borderline Personality Disorder
INTENSE, UNSTABLE, EXTREMES




Chronic instability of emotions, self-image, relationships
Self-destructive behaviors
Intense fear of abandonment and emptiness
Relationships:
* high maintenance; turmoil, chaos
* baffling and exhaustive to others
* require constant attention to soothing moods and stroking
insecurities
* extremes of closeness and distance


Possible history of childhood physical, emotional, or
sexual abuse
75% of diagnosed cases are women
Histrionic Personality Disorder
“High Drama”





Displays a shallow, attention-getting
emotionality.
Histrionic individuals go to great length to
gain others’ praise and reassurance.
Constantly seeking
*Attention (uncomfortable when not the center)
*Reassurance
*Approval
Flamboyant
Inappropriately flirtatious/seductive
Narcissistic Personality Disorder
Grandiose entitlement







Exaggerate their own importance, aided by success
fantasies.
Sees self as unique
Feels entitled to admiration, recognition, special
privileges; enraged when they don’t get that
Excessive and constant need for admiration
Oriented toward success and perfection
Lacks empathy
Relationships:
*Must have their own way *Focused on their own needs
*Tends to engulf others with their needs
*Charms others to get needs met
Avoidant Personality Disorder:
Involvement is risky









Widespread and longstanding discomfort
Shy, distant; exaggerates risk that people pose
Hypersensitivity to evaluation
Feelings of inadequacy
Avoid social activities that involve contact with others
Stays in corners at parties tongue-tied
Always expecting to say something foolish
Highly anxious around others and anxious about
looking anxious
No close friends or confidants; easily slides into
dependence after taking a risk on others
Dependent Personality Disorder:
Excessive need to be taken care of; limited sense of self








Widespread and longstanding dependency on and
submissiveness to others
Even routine daily decisions require advice and
reassurance
Complete passivity; letting others decide
Discomfort, fear, and helplessness about being
alone; goes to great lengths to avoid being isolated
Highly sensitive to disapproval
Willingness to go along with others even it conflicts
with their own wishes or values
Paralyzed by the idea of independent thought/action
Drives people away with neediness
Obsessive-Compulsive Personality
Disorder: All about order and structure








Perfectionistic and inflexible
Focus on detail; order; structure; lists
Performance never good enough
Stubbornly demanding that others do things their
way; very controlling
Overly conscientious and concerned with moral and
ethical issues
Scrupulous to the point of rigidity
Judges others and self very harshly; demands
perfection
Not emotionally expressive; distrusts and
disapproves of emotion in others
Neurodevelopmental Disorders

Disorders first noticed and diagnosed in


Infancy, Childhood, and Adolescence
Resulting deficits cause difficulties in personal, social,
and academic functioning
Global disorders affect us across many arenas of life.
Discrete disorders affect us in some particular and
specific way
100
Neurodevelopmental Disorders
Intellectual Disability
formerly termed Mental Retardation
IQ of 70 or less, but this is not the only determiner as
there must also be cognitive deficits and issues in adaptive
functioning that are found in one or more areas:
conceptual, social, practical
prenatal alcohol exposure is the largest environmental
to genetic factor for IDD
101
Autism Spectrum

The DSM-5 integrates four disorders into
the broader category/spectrum






Autistic disorder
Asperger’s disorder
Childhood disintegrative disorder
PDD-NOS
DSM-IV had 2,027 ways to meet the diagnostic criteria;
DSM-5 has 11
Two major diagnostic criteria


Deficits in social communication and interaction
Restricted and repetitive behaviors, interests, and
activities (RRBs)
102
ADD and ADHD

Attention-Deficit/Hyperactivity Disorder



Issues regarding impulsivity, inattentiveness, and
hyperactivity with several symptoms in each
category
Adults: may suffer even if not diagnosed in childhood; about 4.4% of
adults, those who are diagnosed in childhood and continue to have the
disorder (between 30-50%) are 5 times more likely to commit suicide
than ADHD adults who did not have it in childhood
Adults: need 5 symptoms in the areas of impulsivity, inattentiveness, or
hyperactivity

Onset of symptoms prior to age 7—need 5 to be diagnosed

For onset of symptoms between 7-12—need 6 to be diagnosed
103
Neurocognitive Disorders

Deficits in cognitive functioning that are
acquired rather than developmental



delirium
dementia
amnestic


While these do develop over time in humans, it is
toward the end of our life spans
Also evaluated on a spectrum of mild, moderate,
severe
104
Neurocognitive Disorders

Symptoms need to demonstrate a significant
decline in level of functioning before being
diagnosed

6 cognitive domains considered:
 executive functioning
 learning and memory
 complex attention
 language
 perception
 motor skills
105
9 Major Categories of Psychological
Disorders
DEPRESSIVE and BRIPOLAR
DISORDERS:
A mood disorder results in an inability to
control or stabilize mood.
In a disorder of this type, a patient will have
trouble emerging from a depressed
state or will lack the ability to maintain
mood at a constant level.
Characterized by emotional extremes.
Major Depressive Disorder
Depression is the “common cold” of
psychological disorders. In a year, 5.8% of men
and 9.5% of women report depression
worldwide (WHO, 2002).
Blue mood
Major Depressive Disorder
Gasping for air after a
hard run
Chronic shortness of
breath
Major Depressive Disorder
Major depressive disorder occurs when signs of
depression last two weeks or more and are not
caused by drugs or medical conditions.
1.
2.
3.
4.
Signs include:
Lethargy and fatigue
Feelings of worthlessness
Loss of interest in family & friends
Loss of interest in activities
Symptoms of Major Depression
Dysthymic Disorder



Chronic, low-grade depressed feelings
that are not severe enough to be major
depression
May develop in response to trauma, but
does not decrease with time
Can have co-existing major depression
Seasonal Affective Disorder



Cyclic severe depression and elevated
mood
Seasonal regularity
Unique cluster of symptoms




intense hunger
gain weight in winter
sleep more than usual
depressed more in evening than morning
Depressive Disorders
Depressive Disorders
 The
vicious
cycle of
depression
can be
broken at
any point
Bipolar Disorders
§
§
§
§
§
§
§
a mood disorder in which the person alternates between the
hopelessness and lethargy of depression and the overexcited
state of mania
formerly called manic-depressive disorder
Onset usually in early twenties
Mood changes more abrupt than depression
No gender differences in rate of bipolar
Can be controlled with lithium (medication)
Manic Episode
§ a mood disorder marked by a hyperactive, wildly
optimistic state
Bipolar Disorder
Formerly called manic-depressive disorder. An
alternation between depression and mania
signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.
Whitman
Wolfe
Clemens
Hemingway
 PET scans show
that brain energy
consumption
rises and falls
with emotional
switches
Depressed state
Altering
any one
component
of the
chemistrycognitionmood
circuit can
alter the
others
Manic state
Depressed state
Explaining Depressive and
Bipolar Disorders

Neurotransmitter theories (Biology)




dopamine
norepinephrine
serotonin
Genetic component

more closely related people show similar
histories of mood disorders
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
Situational Bases for Depression


Positive correlation between stressful life events
and onset of depression
 Does life stress cause depression?
Most depressogenic life events are losses
 spouse or companion
 long-term job
 health
 income
Cognitive Bases for Depression

A.T. Beck: depressed people hold pessimistic
views of




themselves
the world
the future
Depressed people distort their experiences in
negative ways


exaggerate bad experiences
minimize good experiences
Cognitive Bases for Depression

Hopelessness theory



depression results from a pattern of
thinking
person loses hope that life will get better
negative experiences are due to stable,
global reasons

e.g., “I didn’t get the job because I’m stupid
and inept” vs. “I didn’t get the job because the
interview didn’t go well”